[Introduction of Percutaneous Dilational Tracheotomy in Otolaryngology Residency Training].

In 2009, we introduced percutaneous dilational tracheotomy (PDT) in otolaryngology residency training. PDT was performed in 21 cases and five residents had an opportunity to learn PDT. No major complications occurred. Decannulation was achieved in 17 of the 18 cases, excluding 3 mortalities. All residents felt that their knowledge of PDT had advanced. Introduction of PDT has great significance in otolaryngology residency training.

[A videoendoscopic swallowing examination using a scoring system for prediction of successful oral intake after discharge from an acute care hospital].

It is often difficult to decide whether to restart an oral diet during acute hospitalization. We investigated retrospectively the predictive factors for successful oral intake after discharge from an acute care hospital or transfer to a recovery rehabilitation hospital. A total of 45 inpatients were enrolled, presenting with dysphagia due to various diseases during hospitalization in an acute care hospital. Between October 2011 and December 2012 the patients were examined with a videoendoscopic examination of swallowing (VE). We classified the feeding procedure after discharge from the hospital into three groups-the first group (group 1) had no oral intake limitation, the second group (group 2) had limited oral intake, and the third group (group 3) had no oral intake ability. We then assessed the factors of age, sex, VE score, and functional independence measure (FIM) score to compare the activities of daily living (ADL) between group 1 and group 2 + 3. FIM score consists of motor and cognitive scores. We observed a statistically significant difference in age, VE score, motor FIM score and cognitive FIM score in a univariate analysis (p = 0.03, p = 0.0036, p = 0.0019, p = 0.0125). The VE score also showed a statistically significant difference in a multivariate analysis (p = 0.0396), indicating that the VE score was an independent variable related to prediction of the feeding procedure. A VE score of 4 as the cut-off point between group 1 and group 2 + 3 provided a specificity of 0.944 and a positive predictive value of 0.923. On the other hand, a VE score of 9 as the cut-off point between group 3 and group 1 + 2 provided a specificity of 0.969 and a positive predictive value of 0.857. These results indicate that the VE score is a useful tool for the prediction of successful oral intake after discharge from an acute care hospital. In addition, age and ADL are also useful predictive factors for the feeding procedure.

[Hearing loss of aging].

The gradual hearing loss is seen in every people as they get older. In this symposium, anatomy and physiology of the ear were talked at first. Next, diseases which cause hearing disturbance were explained. Especially, we focused on the age-related hearing loss. It was emphasized that we should speak to elderly people very slowly and clearly so that they could understand us well. At last, the usefulness and progress of hearing aids were introduced. It is very important to tune their hearing aids to the individual. We hope that this symposium would help the attendance to enjoy every day of their lives.

Downbeat positioning nystagmus is a common clinical feature despite variable phenotypes in an FHM1 family.

Clinical examinations and mutational analyses were carried out in three patients of a Japanese familial hemiplegic migraine (FHM) pedigree. Each affected member demonstrated a broad clinical spectrum that included hemiplegic migraine with progressive cerebellar ataxia, migraine without aura, and episodic ataxia. Despite this variability, all members exhibited marked downbeat positioning nystagmus, and magnetic resonance images (MRI) all showed cerebellar atrophy predominantly of the cerebellar vermis. All affected members had a T666M missense mutation in the protein encoded by the CACNA1A gene (calcium channel, voltage-dependent, P/Q type, alpha 1A subunit). Although clinical features associated with the T666M CACNA1A mutation are highly variable, downbeat positioning nystagmus may be an important clinical feature of this disease.

Prediction in the timing of pursuit eye movement initiation revealed by cross-axis vestibular-pursuit training in monkeys.

The smooth-pursuit system interacts with the vestibular system to maintain the image of a moving target on the fovea. Efficient tracking performance requires information about the velocity and the initiation of target motion. Previous studies in monkeys have shown that training with orthogonal pursuit and whole body rotation results in adapted eye movement direction during chair rotation. In addition, the latency of the pursuit shortens and initial eye velocity increases in a task-dependent manner. To examine whether these adapted eye movements are predictive pursuit, we studied whether our monkeys could predict the timing of smooth eye movement initiation during chair rotation. Two young Japanese monkeys were rotated horizontally in a trapezoidal waveform (20 degrees/s, +/-10 degrees) with random inter-trial intervals. A laser spot was moved vertically with the same trajectory at a constant delay ranging from 100 to 700 ms after the onset of the chair motion. The monkeys were required to pursue the spot. After this training, the latencies of pursuit eye movements following the onset of chair motion were examined in the presence of the target motion. The target was also briefly (for 500-700 ms) extinguished at 80 ms after the onset of chair rotation. Pursuit eye movements after training were initiated before the onset of target motion and the latencies were proportional to the delays used for training. The latencies and response magnitudes of pursuit with or without target blanking were similar. The auditory-pursuit training did not induce an initial pursuit response similar to that induced by vestibular-pursuit training. These results indicate that smooth eye movements during the chair rotation after the vestibular-pursuit training included a predictive pursuit component. The monkeys' estimate of the delays revealed by the latencies of pursuit was shorter by 22-36% than the actual delays.